Skaneateles Country Club Sail School 2013

PO Box 29, Skaneateles, NY 13152 315-685-5759




2013 Sail School Registration Form
Deadline June 15, 2013
Contact Information
Student Name:
Age:
Birthday:
Address:
Phone:
Parent/Guardian Name:
Address:
Home Phone:
Work Phone:
Cell Phone:
Email:
Emergency Contact:
Phone:
Emergency Contact:
Phone:
Beginner 1
Monday, Wednesday 9:00-12:30
1st Session July 2-July 23
2nd Session July 24-August 13
Full Session July 2-August 13
Beginner II
Tuesday, Thursday 9:00-12:30
1st Session July 2-July 23
2nd Session July 24-August 13
Full Session July 2-August 13
Intermediate
Tuesday, Thursday 1:30-4:30
Friday 9:00-12:30
1st Session July 2-July 23
2nd Session July 24-August 13
Full Session July 2-August 13
Advanced/Race Coaching*
Monday, Wednesday 1:30-4:30
Friday 9:00-12:30
1st Session July 2-July 23
2nd Session July 24-August 13
Full Session July 2-August 13
Registration Rules- Registration is incomplete without medical form and payment. Minimum age 7 years old. Only half and full sessions available; no weekly rates. Registration deadline is June 15, 2013; add $25 for late registration. * Fifty dollars off/session to racer who brings laser while enrolled

School closure- Sail School will be closed Thursday, July 4th.

Payment- Please make checks payable to Skaneateles Country Club; members may charge Sail School to their accounts. Be sure to include payment for Sail Wear with registration. See product photos at http://www.skaneatelescc.com
Sail Wear
*Please choose "No Thanks" in the menu below if not interested in sail wear.
T-Shirt ($15):
Hoodie ($45):
Sail School Caps ($25) (one size fits all):
Questions- Janice Wiles, Director 240 626 5209 email: sccsailschool@gmail.com; SCC office: 315 685-5759
Method of Payment
Check #:
Account:
Date:
Medical Information & Authorization
To ensure the safety of your children when involved in the Skaneateles Country Club Sail School each parent/guardian must fill out this form for each registered child. This form will be filed in the SCC Sail School office, located in the Foc’sle, as well as in the club main office. This form will accompany any child while participating in any Sail School activity off the club grounds, i.e. racing class students.
Allergies:
Type of Reaction:
Treatment Required:
Special Needs/Conditions:
Family Physician:
Phone:
Emergency Contact:
Relationship:
Cell Phone:
Work Phone:
Health Insurance Carrier:
ID#:
Group #:
Medical Authorization:
The undersigned parent/guardian of (child's name) a minor, does hereby authorize the SCC Sail School Staff to act in my absence to authorize or consent to any emergency X-ray, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any physician or surgeon licensed under the provision of the Medical Practice Act. It is understood this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician, in the exercise of his best judgment, may deem advisable; and neither said agent or any organization involved assumes any financial responsibility for exercising this action. This authorization shall remain effective until revoked, in writing.
Signature: Parent/Guardian:
Date:

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